CARE HOMES FOR OLDER PEOPLE
Bethany Homestead Kingsley Road Northampton Northants NN2 7BP Lead Inspector
Mrs Helen Wilson Unannounced Inspection 29th June 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000012601.V301688.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000012601.V301688.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Bethany Homestead Address Kingsley Road Northampton Northants NN2 7BP Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01604 713171 01604 716315 The Trustees of Bethany Homestead Mrs Kathleen Margaret Coxhill Care Home 50 Category(ies) of Dementia - over 65 years of age (6), Old age, registration, with number not falling within any other category (50), of places Physical disability over 65 years of age (10) DS0000012601.V301688.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The total number of service users must not exceed 50 To be able to admit the named person of dual category DE(E) MD(E) named in variation application V000031157 dated 31.03.06 26th January 2006 Date of last inspection Brief Description of the Service: The home is registered to provide care to 50 residents over 65 years of age in the category of OP, five people may also be in the category of Dementia DE (E) and 10 people may have a Physical Disability PD (E). It is situated in a purpose built facility close to the town centre and local amenities. Refurbished in recent years in to bring it up to modern standards, the home is run by a board of trustees and admits service users who are members of non-conformist churches in the town. Residents are accommodated over three floors with lift access for those with mobility problems. There is a mixture of single and double rooms, all of which have en-suite facilities. The home is set within a complex of sheltered housing and a community centre to which service users have access. The current fees range from £440.00 to £470.00 with additional costs for extras such as hairdressing, newspapers, transport, chiropody and testing of portable electrical appliances belonging to service users. DS0000012601.V301688.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is on outcomes for Service Users. This process considers the home’s capacity to meet regulatory requirements, minimum standards of practice, and focuses on aspects of service provisions that need further development. The inspection was carried out unannounced on 29 June 2006 and lasted approx seven hours in total. Discussions were held with the Registered Manager, care staff and catering staff and selected records were examined relating to the running of the home. The primary method of inspection used was ‘case tracking’ which involved selecting three people using the service and tracking the care they receive through review of their records and discussion with them where possible. Due to the current condition of some residents’ health direct discussion was not appropriate and some of the judgements made at this inspection are based on general observations and discussion with other residents and visitors. Requirements identified at the previous inspection were reviewed and in the main had been successfully met. One item remains relating to care planning that needs to be further addressed. It was useful to be able to discuss and explain directly the findings of the inspection with the Registered Manager and reach agreement on the way any identified issues can be resolved. What the service does well:
The environment of the home is maintained to a high standard, giving service users a bright, pleasant place to live inside and out. Residents who spoke with the inspector, unreservedly said that they were very satisfied with the service provided. All residents were unanimous that the staff team were caring, approachable and that they felt comfortable with each carer. All staff were friendly and helpful with residents. Observations of staff interaction with residents indicated that care was being given in a way that maintained personal dignity and independence. Residents and visitors were
DS0000012601.V301688.R01.S.doc Version 5.2 Page 6 asked for their views of the home and the service provided and unanimously their views and comments were positive. There was a calm environment with residents engaged in various conversations and meeting friends. The home has several volunteers coming in regularly to assist with a programme of leisure and social activities. The kitchen is well organised and experienced catering staff prepare and serve a range of home cooked traditional meals every day. Alternative choices for each meal are available and the main meal seen at lunchtime was appetising and of appropriate quantity. Residents confirmed that the food was regularly of a high standard. Records relating to the safe-keeping and disbursement of residents’ personal monies were sound and fully receipted. What has improved since the last inspection? What they could do better:
Assessment and care planning documentation still needs to be improved to ensure that staff are given the relevant information and guidance to meet the needs of each resident. Due to staff having cared for the residents for long periods of time, an over reliance on the personal knowledge held by staff
DS0000012601.V301688.R01.S.doc Version 5.2 Page 7 rather than written care planning has developed; this has the potential for inconsistencies in the way daily care routines are done. Care plans should be made clearer on how care staff members are to carry out care tasks so that residents experience consistent care practices. There is no evidence of a regular supervision programme for staff. The Registered Manager has agreed that this will be put in place to give opportunities for discussion of training, feedback on work performance and as support for each staff member. Staff members identified that they had not had any update of moving and handling training. From resident case file records it was evidenced that staff are using hoists and assist an increasing number of people with their mobility and this relies on staff using current safe handling practices. The Registered Manager stated she would make arrangements for staff to attend courses to meet their individual training needs. Overall the business records of the home could be better managed and documentation required for inspection purposes kept in a more organised way. For example records relating to premises checks made under Health and Safety of the building and its facilities were in disarray and confirmatory evidence unavailable during inspection of specific maintenance. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. DS0000012601.V301688.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000012601.V301688.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are provided with comprehensive information about the home and the service they will receive and pre-admission assessment processes ensure that needs are identified and agreed with the potential residents. EVIDENCE: People are provided with an information pack including the agency’s Statement of Purpose, information on staff training, contact numbers for use in an emergency, guidance on what to do if they are unhappy with the service and wish to complain, including the contact number and address of the Commission. The home uses an assessment process that covers in detail all activities of daily living to identify specific care needs of a potential resident and then reviews and updates this care plan regularly when the resident is cared for by Bethany Homestead.
DS0000012601.V301688.R01.S.doc Version 5.2 Page 10 Both staff members who were interviewed demonstrated knowledge and understanding of the needs of the people they support and were familiar with how personal care tasks were undertaken with each particular resident. Staff confirmed that flexibility of routines allowed care to be centred around individual wishes. Residents who spoke with the inspector, unreservedly said that they were very satisfied with the service provided. All residents were unanimous that the staff team were caring, approachable and that they felt comfortable with each carer. DS0000012601.V301688.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal care needs of residents are well met, however, the care plan and risk assessment guidance for staff needs to be improved to ensure that there is consistency in the way care is given. EVIDENCE: Residents said that the staff team were caring, approachable and that they felt comfortable with and respected by each carer. Although residents who spoke with the inspector, unreservedly said that they were very satisfied with the service provided, assessment and care planning documentation still needs to be improved to ensure that staff are given the relevant information and guidance to meet all of the service users needs. Due to staff having cared for the residents for long periods of time, an over reliance on personal knowledge rather than written care planning has developed and this has the potential for inconsistencies in the way daily care routines are done. Care plans should be made clearer on how care staff members are to carry out care tasks so that service users experience consistent care practices.
DS0000012601.V301688.R01.S.doc Version 5.2 Page 12 Two casefiles showed that, despite staff knowledge of mobility risks and increased needs for assistance, the written notes were not cross-referenced to altered plans for moving and handling for two residents. One person admitted for short-term care at very short notice had no written care plan for mobility to direct staff. In discussion with the Registered Manager it was identified that senior staff need additional training in moving and handling assessment to ensure that risk assessments and plans for safe assistance are drawn up. Recording in the service users’ daily log sheets relating to care given has been improved with staff detailing important information. This evidences regular input from care staff, a wide range of social activities attended and any variances in the health of residents necessitating contact and visits from GPs. The Registered Manager said she was aware that recording of night shift details still needs improving and this is being developed. The medication system, including receipt of supplies, administration to service users, and disposal of stock to the dispensing pharmacist has been greatly improved and is now satisfactory. The Registered Manager has initiated a system for random spot checks to ensure that the administration of medication is safe. The sliding door to the upstairs medication storeroom has been fitted with a padlock to ensure that access is restricted to staff keyholders only. Receipt, administration and disposal of controlled drugs are recorded in a register with all stock held in a separate metal cabinet to comply with current safety standards. DS0000012601.V301688.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home succeeds in providing residents with choices in their lifestyle and social activities giving support and assistance where necessary for individual people to remain involved in daily interests. EVIDENCE: The home offers residents opportunities for religious observance each week. There is also a choir that has a wide repertoire and is in demand in the wider community at events. There was a calm environment in the home with service users engaged in various conversations and meeting friends or choosing to remain in their own private bedrooms. The home has several volunteers coming in regularly to assist with a programme of leisure and social activities. Staff, residents and visitors spoke of a wide range of social events arranged regularly; these have included narrow-boat trips, outings to country parks, bingo, musical evenings, shopping trips, in-house clothes sales, exercise to music classes, garden fetes, Italian meal night, etc.
DS0000012601.V301688.R01.S.doc Version 5.2 Page 14 Staff were seen encouraging residents to make choices and decisions about their daily routines and meals. The home offers a facility for residents to deposit personal monies for safe-keeping and the records relating to this were sound and fully receipted. The kitchen is well organised and experienced catering staff prepare and serve a range of home cooked traditional meals every day. Alternative choices for each meal are available and the main meal seen at lunchtime was appetising and of appropriate quantity. Residents confirmed that the food was regularly of a high standard. DS0000012601.V301688.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has provided staff with training about the potential safeguarding of residents from abuse. There is an open atmosphere in the home and residents can raise any issue with confidence with the Registered Manager. EVIDENCE: Staff confirmed they had attended training on awareness of Protection of Vulnerable Adults and were knowledgeable about how any such suspicions would be reported. A family visitor and a resident confirmed that they would be able to be confident in raising any concern or complaint directly with the Registered Manager to have an issue resolved. There has been no complaint made to CSCI or directly to the home in recent months. DS0000012601.V301688.R01.S.doc Version 5.2 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well-maintained and provides homely, comfortable and hygienic environment for residents. Replacement of two hoists should be given priority consideration to safeguard residents and staff when assisting with moving and handling. EVIDENCE: The environment of the home is maintained to a high standard, giving service users a bright, pleasant place to live. Lounges, conservatory, dining room and corridors were clean, well furnished and decorated and residents enjoy making use of these areas. Outside seating areas encourage residents to use the garden and many people were observed walking around the grounds. DS0000012601.V301688.R01.S.doc Version 5.2 Page 17 The home has assisted baths to enable residents to continue to bathe in dignity and safely. Residents have a variety of mobility equipment such as walking frames, electric and manual wheelchairs and the home currently has five hoists for use with residents who have particular care needs. Staff informed the inspector that one hoist on the ground floor was not operating properly despite regular maintenance repairs and one other could only be moved sideways along corridors by staff and was a potential hazard to residents walking. These comments were relayed to the Registered Manager who confirmed these were known difficulties and that replacement of the items could be considered. Bedrooms were clean, well furnished including small items of furniture, ornaments and framed photographs belonging to individual residents and pleasantly decorated. There were no unpleasant odours in the home. Domestic staff were observed cleaning all areas of the home in an efficient way without disruption to the residents. DS0000012601.V301688.R01.S.doc Version 5.2 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home operates a robust recruitment process for staff. The staff group is very stable and long-term and there are adequate numbers of staff on duty to meet the needs of residents. EVIDENCE: Residents were unanimous that the staff team were caring, approachable and that they felt comfortable with each carer. Three staff files were examined and these evidenced that robust recruitment had taken place and files included evidence of satisfactory Criminal Record Bureau disclosure checks. Staff members identified that they had not had any update of moving and handling training. This training should be organised as a priority as it was noted from resident case files that staff are having to hoist of assist an increasing number of people and this relies on staff knowledge of current safe practice. The Registered Manager stated she would make arrangements for staff to attend courses to meet their individual training needs. DS0000012601.V301688.R01.S.doc Version 5.2 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36,37 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a clear style of management and atmosphere in the home that values and engages with staff, service users and families. Regular staff supervision sessions need to be introduced. Although records need to be better managed, the home is being run in the best interests of the residents. EVIDENCE: The home is run by an experienced manager with the skills required to ensure that it is run for the benefit of service users. It is accepted that in a large home of fifty beds that some tasks that are the responsibility of the Registered Manager will be delegated to others. Care planning and risk assessments need improving and documentation needs to be clear to guide staff.
DS0000012601.V301688.R01.S.doc Version 5.2 Page 20 Records relating to the safekeeping and disbursement of service users’ personal monies were sound and fully receipted. Overall the business records of the home could be better managed and documentation required for inspection purposes kept in a more organised way. For example, records relating to premises checks made under Health and Safety of the building and its facilities were in disarray and confirmatory evidence unavailable during inspection of specific maintenance. A member of the Board of Trustees carries out a monthly monitoring check at the home to ensure that the home is being conducted in a satisfactory manner. From checking three staff files there is no evidence of a regular supervision programme for staff. The Registered Manager said it had been some time since staff had been supervised apart from observation of practices and has agreed that regular supervision will be put in place to give opportunities for discussion of training, feedback on work performance and as support for each staff member. DS0000012601.V301688.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 3 2 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 2 3 3 DS0000012601.V301688.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement Care plans and risk assessments must be detailed and be clear on how care staff members are to carry out care tasks so that residents experience safe and consistent care practices. These plans must be regularly reviewed and formulated in conjunction with the service user or their advocate. This is an unmet requirement from the previous inspection of with an original date for compliance by 30.04.06. Timescale for action 31/08/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP22 Good Practice Recommendations Priority consideration should be given to replacing the two hoists currently used on the ground floor.
DS0000012601.V301688.R01.S.doc Version 5.2 Page 23 2. OP36 A programme of regular supervision sessions for each staff member should be established. DS0000012601.V301688.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Northamptonshire Area Office 1st Floor Newland House Campbell Square Northampton NN1 3EB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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